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Find
all of Dr. Taub’s articles on Stroke Rehabilitation
listed on the Doctor Shopping & Your
Patients with Chronic Pain to see a list of other articles
from the private practice of Neal S. Taub, MD. |
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A Letter Released
to Physicians on November 7, 2006 Providing Advanced Treatments for Recalcitrant Headaches Every year, 17%
of women and 14% of men present themselves to a primary care practitioner
looking for relief from headaches.1 Unfortunately, more than five percent of
the adult population experiences recurring headaches that do not respond
satisfactorily to conventional care.2,3 Effects can range from poorer quality of
life, to impairment, to disability.4 In these cases, please consider a referral
to Neal S. Taub, MD, Physiatrist for specialized pain medicine. The private practice of Dr. Taub makes a
number of specialized services and treatments available to your patients
suffering from chronic headaches: trigger point injections, occipital nerve
blocks, chemical neurolysis, medical acupuncture,
therapy supervision, analgesic consultation & monitoring, pre-surgical
second opinions, etc. Here, we review
three of the specialized treatments that often provide rapid relief for
chronic headaches. Muscle
Injections: While cervicogenic elements contributing
to chronic headaches may sometimes go unaddressed in initial treatment plans,
studies suggest that as many as 35% of medically treated headaches are
cervicogenic in nature.5
Various reports have demonstrated that muscular lesions of the cervical
spine and/or shoulder (i.e. trigger points, spasm, hypertonicity)
can result in referred pain subjectively experienced in the anterior or posterior cranial muscles.6-12 While there are many methods for addressing
trigger points, injection has been shown to be one of the most efficient and
effective modalities for prompt relief of symptoms.13 When the muscular dysfunction contributing
to recurring headaches is more diffuse than trigger points (i.e. spasm, hypertonicity), botox
injections into problematic muscles may prove helpful in breaking the pain
cycle.14,15 Occipital
Nerve Blocks: Occipital nerve blocks are
injections of anesthesia, sometimes in conjunction with a steroid, into
peripheral nerves at the back of the neck.
This treatment blocks pain impulses from damaged structures and
potentially reduces inflammation.
Because the injections are relatively superficial and locally acting,
side effects are rare when performed correctly. The occipital nerve may
participate in many types of headaches.
One common presentation that indicates occipital nerve involvement is
the experience of pain that starts at the back of the head and then spreads
toward the forehead. Of course,
occipital neuralgia suggests the use of occipital nerve blocks. Clinically, occipital neuralgia usually
presents as a pain in the dermatomal distribution
of an occipital nerve. In 2/3 of
cases, pain is unilateral.16 Patients typically describe the pain
as lancing, electric, or shock-like. Nerve block injections can be both
diagnostic and therapeutic. Repeated
blocks can provide permanent relief,17 or
indicate that an ablation or neurolysis would
probably provide permanent relief. Chemical
Neurolysis (Phenol or Botox): This injection treatment results
in the destruction or dissolution of nerve tissue, typically a dorsal root
ganglion. Pain relief effects can be
temporary or permanent. Chemical neurolysis can serve as a preferable alternative to
surgical ablation. Please
refer your patients to Neal S. Taub, MD, Physiatrist |
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Home Stroke Rehabilitation About Neal Taub, MD What is a Physiatrist |
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